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Please fill out the form below if you are interested in piano lessons. We will get back to you soon to discuss placement!

Parent Name

First Name

Last Name

Parent Email Address

Address

Street, City, Zip

Phone Number

(###)

###

####

Preferred Method of Contact

Student Name

If you have more than one student to enroll, please include their information at the end of this form in the Notes section.

First Name

Last Name

Student Birthdate

YYYY

Has your child taken lessons before? For how long?

How did you hear about us?

Notes

Anything else we should know?

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